Safe Resident Lifting in Long-Term Care (LTC)

Patricia W. Gucer, PhD Marc Oliver, RN, MPH

Joanna Gaitens, BSN, PhD Melissa A. McDiarmid, MD, MPH

Occupational Health Program

University of Maryland School of Medicine

Twenty years of accrued evidence shows:

1. Manual resident lifting causes caregiver Injury Marras et al, 1999 Marras et al. 2000 2. Use of Powered Mechanical Lifts reduces caregiver injuries/workers compensation costs: Evanoff et al 2003 Collins et al. 2004 Brophy et al, 2001 Park et al. 2009

However, there was a lack of such data 1. National Samples and 2. When separating lift numbers or use from a safe lift process

Safer Resident

Lifting Attitudes,

Policies and Procedures

and

Powered Mechanical

Lifts

Caregiver Injuries and

Workers’ Compensation Lift-Related Costs

Safe Resident Lifting in Long-Term Care (LTC)

Benefits Workers and Residents

Data from National Council on Compensation Insurance (NCCI)

Data from survey of Directors of Nursing at Long-term Care facilities, N=271

Data from the Centers for Medicaid and Medicare Services (CMS)

Worker Benefits Resident Benefits

Physical Restraints

Antipsychotic Drugs

Bedfastness

Bed sores

Falls

Fractures

This work supported by the Commonwealth Fund

Safe Lift Index: Elements Derived from our DON Survey (N=271 from 23 states)

For residents not able to move around on their own 1. Do procedures require powered mechanical lift (LIFTS) use? 2. Do their care plans require the use of LIFTS? For all caregivers 3. When a CNA’s job performance is being evaluated, is the use of LIFTS mentioned? 4. Are newly hired CNAs trained in how to use LIFTS? 5. May two caregivers lift a resident manually? DON preferences for using LIFTS to 6. Lift a resident weighing 150 lbs from bed to chair 7. Lift a resident weighing 90 lbs from bed to chair DON perceived barriers to lift use 8. Resident rooms too small 9. Residents afraid of LIFTS 10. Maintenance problems, not enough slings, battery dead etc. 11. Stringency of enforcement of violations

Full lift Resident is passive

Sit-Stand lift Resident works to raise him/herself

How many LIFTS in your facility? Asked of DONs in our survey

Table 2

Explanatory Variable Coefficient Standard Error Significance (intercept) -0.1465 0.2283 Lifts per Resident -0.0101 0.0110 Safe Lift Index -0.0209 0.0082 ** State Frequency 0.4995 0.1703 *** For Profit -0.1744 0.0887 ** Government -0.1713 0.1430

(Log of scale parameter) -0.8347 0.0549 ***

Note ***,**,* significance at 1%, 5% and 10% levels, respectively

Workers Compensation Total Costs Tobit Model

Facility Safe Lift Index predicts workers compensation costs

An of 1 lift/100 residents is associated with an 11% in costs

A one standard deviation in the safe lift index is associated with a 33% in costs

Safer Resident

Lifting Attitudes,

Policies and Procedures

and

Powered Mechanical

Lifts

Caregiver Injuries and

Workers’ Compensation Lift-Related Costs

Safe Resident Lifting in Long-Term Care (LTC)

Benefits Workers and Residents

Data from National Council on Compensation Insurance (NCCI)

Data from survey of Directors of Nursing at Long-term Care facilities, N=271

Data from the Centers for Medicaid and Medicare Services (CMS)

Worker Benefits Resident Benefits

Physical Restraints

Antipsychotic Drugs

Bedfastness

Bed sores

Falls

Fractures

Resident outcomes derived from Centers for Medicare & Medicaid Services (CMS)

Minimum Data Set (MDS)

The MDS tracks well-being measures (i.e. restraint use and bed sores in facilities receiving Medicare or Medicaid).

(Omnibus Reconciliation Act of 1987 (OBRA-1987).

MDS data are collected on site and submitted quarterly. We used these CMS data for resident outcomes.

Resident Mobility-Related Well-being Outcomes: From the CMS Minimum Data Set (MDS)

Percent of Residents who: • Were physically restrained • Were given antipsychotic drugs w/o a dx of psychosis • Spent most of their time in bed or in a chair • Had pressure ulcers while at high risk • Fell in the past 30 days • Broke a bone in the last quarter

Resident well-being outcomes stratified by levels of the safe lift index: 2007

Percent of facility residents who

Safe Lift index by low vs. high*

Physical restraint

Antipsychotic medication

without psychosis

Bedfast Pressure

Ulcers Fell Broke a bone

low n=126 Mean 4.03 21.33 3.06 13.72 15.42 1.59

SD 5.64 9.12 3.68 8.72 5.27 1.09

high n=132 Mean 3.72 20.51 2.49 12.45 14.49 1.51

SD 5.31 10.54 3.27 6.63 4.32 1.09

Total n=258 Mean 3.87 20.91 2.77 13.07 14.94 1.55

SD 5.47 9.86 3.48 8.43 4.84 1.09

anova p=.615 p=.507 p=.186 p=0.190 p=0.121 p=0.538

* cut is by mid point of the index frequency values in the safe lift index (SLI)

Correlations between LIFT Availability and Resident Outcomes, over 3 Years

Total Lifts a

Full Lifts

Sit Stand Lifts

2005 2006 2007

2005 2006 2007

2005 2006 2007

N=233 b n=247 n=263

N=234 N=248 N=264

N=243 N=251 N=266

Percent of Facility Long - term care residents who:

Were physically restrained

- .144* - 0.201** - .234***

- .100 - .107 - .115

- .159* - 0.234*** - .265***

Received antipsychotic use w/o diagnosis of psychosis

- .240*** - 166** - .183**

- .161* - .072 - .066

- .240*** - .187** - .213***

Spent most of their time in bed or in a

chair

- .239*** - .224** - .219***

- .138* - .148* - .077

- .238*** - 0.193** - .238***

Had pressure ulcers while at high risk

- .304*** - .261*** - .260***

- .214** - .111 - .014

- .322*** - .280***

. - .278***

Fell in the past 30 days

.232*** .169** .126*

.176** .040 .036

.217** 0.269*** .159*

Broke a bone in the last quarter

.209** .157* .086

.153* .034 .040

.157* .243*** .181**

Correlations are non parametric, using

Spearman tests of significance, *<.05 prob,, **<.01 prob. , ***. <.001 prob.

Resident Well-being Improves as Lift Number Increases

Percent of facility residents who

Sit Stand Lifts / 100 Residents (2007)

0 to 1

LIFTS >1 to 2 LIFTS

> 2 to 3 LIFTS

>3 LIFTS

Tukey post hoc 0-1 to >3

n=65

n=56

n=42

n=102 Prob

Were physically restrained Mean 5.73 5.11 2.62 2.60 0.001

SD 6.89 5.89 3.96 4.20

Had pressure ulcers while at high risk

Mean 16.10 14.34 11.95 9.62 0.000

SD 9.01 8.19 6.59 6.12

Multivariate Analysis: Significant associationsa between resident well-being outcomes and safe lift predictors

Resident Well-Being Outcomes

Physical restraint Antipsychotic

drug use Bedfastness Pressure ulcers Falls Broken bones

sign

p valu

e sign p value sign p value sign p value sign p value sign p value

Predictor variables

Sit stand PML/100 residents neg ** neg *** pos ** pos ***

Full lifts/100 residents neg *

Safe lift index neg *

Adjustment variables

Size (number of occupied beds) pos ** neg *** neg ***

Year neg * neg ** neg * pos. *

* p<.05, ** p<.001, *** p < .000

a Results from generalized estimating equations (XTGEE in Stata 11), negative binomial distribution, robust SE, and auto regressive correlation among subjects (facilities)

Safer Resident

Lifting Attitudes,

Policies and Procedures

and

More Sit- Stand

Powered Mechanical

Lifts

Caregiver Injuries and

Workers’ Compensation Lift-Related Costs

Safe Resident Lifting in Long-Term Care (LTC)

Benefits Workers and Residents

Data from National Council on Compensation Insurance (NCCI)

Data from survey of Directors of Nursing at Long-term Care facilities, N=271

Data from the Centers for Medicaid and Medicare Services (CMS)

Worker Benefits Resident Benefits

Restrepo T. et al. JOEM. 55. 27-35. 2013.

Falls

Bedfastness

Bed sores

*Falls and Fractures

Gucer P. et al. JOEM. 55. 36-44. 2013.

Safer Resident

Lifting Attitudes,

Policies and Procedures

and

More Sit- Stand

Powered Mechanical

Lifts

Falls

Bedfastness

Bed sores

*Falls and Fractures

*Use of assistive devices increases fall risk Mann, et al, Geriatrics. 1995 Vol 13. 1-23 Mahoney, et, J Gerontology A Biol. 1999, Vol 54. M83-M88 Exercise reduces fall risk Carter, et al, Sports Med. 2001. Vol 21, 127-138